Rafanelli Chiara, Roncuzzi Renzo, Finos Livio, Tossani Eliana, Tomba Elena, Mangelli Lara, Urbinati Stefano, Pinelli Giuseppe, Fava Giovanni A
Department of Psychology, University of Bologna, Bologna, Italy.
Psychother Psychosom. 2003 Nov-Dec;72(6):343-9. doi: 10.1159/000073031.
While there has been an upsurge of interest in the psychiatric correlates of myocardial infarction, little is known about the presence of psychological distress in the setting of cardiac rehabilitation.
A consecutive series of 61 patients with recent myocardial infarction who participated in a cardiac rehabilitation program was evaluated by means of both observer-rated (DSM and DCPR) and self-rated (Psychosocial Index) methods. A follow-up of this patient population was undertaken (median = 2 years). Survival analysis was used to characterize the clinical course of patients.
Twenty percent of patients had a DSM-IV diagnosis (in half of the cases minor depression). An additional 30% of patients presented with a DCPR cluster, such as type A behavior and irritable mood. Only high levels of self-perceived stressful life circumstances and psychological distress approached statistical significance as a psychological risk factor for cardiovascular events after myocardial infarction.
Psychological evaluation of patients undergoing cardiac rehabilitation needs to incorporate both clinical (DSM) and subclinical (DCPR) methods of classification. Type A behavior was present in about a quarter of patients and can be studied in specific subgroups of cardiovascular patients defined by DCPR.
虽然对心肌梗死的精神科相关因素的兴趣有所增加，但对于心脏康复过程中心理困扰的存在情况知之甚少。
采用观察者评定法（DSM和DCPR）和自评法（心理社会指数）对连续61例近期心肌梗死且参加心脏康复项目的患者进行评估。对该患者群体进行了随访（中位数 = 2年）。采用生存分析来描述患者的临床病程。
20%的患者有DSM-IV诊断（半数为轻度抑郁）。另外30%的患者表现出DCPR聚类，如A型行为和易怒情绪。仅自我感知的高压力生活环境和心理困扰作为心肌梗死后心血管事件的心理危险因素接近统计学意义。
对接受心脏康复的患者进行心理评估需要纳入临床（DSM）和亚临床（DCPR）分类方法。约四分之一的患者存在A型行为，可在由DCPR定义的心血管疾病患者特定亚组中进行研究。
